Awareness is key to kidney health

The widening gap between the requirement and availability of kidneys for transplants in India is reflective of both the rise in the number of patients with chronic kidney disease (CKD) as well as poor awareness of organ donation in the country. While efforts to address the twin problems must be intensified, keeping the kidneys healthy can significantly reduce the gap. Official estimates show that the need for kidney transplants has more than doubled over the past decade, but the availability of kidneys for transplant has not increased proportionately in the country. Till about a decade earlier, there was a requirement of more than one lakh kidneys, while only about five thousand kidneys were reportedly transplanted every year. Currently, about 2.2 lakh new patients with end-stage renal disease get added to India every year, resulting in additional demand for 3.4 crore dialysis each year. On average, about 8,000 to 10,000 kidney transplants are done every year, which speaks volumes about the increasing wait time for lakhs of patients. The theme for this year’s World Kidney Day, which is observed on this date every year, “kidney health for all—advancing equitable access to care and optimal medication practice,” has huge significance for India. World Kidney Day (WKD), which is a joint initiative of the International Society of Nephrology and the International Federation of Kidney Foundations (World Kidney Alliance), has been running a global campaign aimed at raising awareness of the importance of the kidneys. The global body points out that over the last three decades, CKD treatment efforts have centred on preparing for and delivering kidney replacement therapies. “However, recent therapeutic breakthroughs offer unprecedented opportunities to prevent or delay disease and mitigate complications such as cardiovascular disease and kidney failure, ultimately prolonging the quality and quantity of life for people living with CKD,” it adds. The WKD insists that while these new therapies should be universally accessible to all patients in every country and environment, barriers such as lack of CKD awareness, insufficient knowledge or confidence with newer therapeutic strategies, shortages of kidney specialists, and treatment costs contribute to profound disparities in accessing treatments, particularly in low- and middle-income countries but also in some high-income settings. These inequities emphasise the need to shift focus towards CKD awareness and capacity building of the healthcare workforce, states the organisation in an official release on this year’s campaign theme. It also underscores the importance of empowering patients and communities and envisages raising awareness about CKD risk factors such as diabetes, hypertension, and obesity and how healthy lifestyle choices, self-care, and promoting long-term adherence to treatment strategies can bring large benefits, especially when initiated early and consistently maintained. The Pradhan Mantri National Dialysis Programme (PMNDP) for CKD patients ensures the availability of dialysis services in all the district hospitals in the country free of charge to all below poverty line (BPL) beneficiaries. The Ministry of Health and Family Welfare has also included a kidney transplant package under the PM-JAY scheme of Ayushman Bharat, while under Rashtriya Arogya Nidhi (RAN), financial support up to Rs. 15 lakh is provided by the Ministry to BPL patients for transplantation of the heart, lung, liver, and kidney. The Medical Officers’ Manual for Prevention and Management of Chronic Kidney Diseases 2022, published by the Directorate General of Health Services under the National Programme for Prevention and Control of Non-Communicable Diseases, lists lifestyle management practices for patients with CKD. This includes smoking cessation, weight reduction, a protein-controlled diet, discouraging alcohol consumption, exercise, and focusing on dietary salt intake. It suggests that a total of 30 minutes of exercise five times a week may be a helpful measure for protection from cardiovascular problems and cautions that higher-intensity exercises should be avoided. Raising awareness about the disease should be a key priority, as global data suggest that only 6% of the general population and less than 10% of the high-risk population are aware of CKD, despite the alarming increase. The guideline explains that CKD cannot be cured by any treatment and is a progressive kidney disease that invariably progresses to end-stage kidney disease. Retardation of the progression of CKD and delaying the need for dialysis and/or kidney transplants remain core conservative management strategies for the disease. The Ministry of Health data shows that nearly 14500 new patients with CKD were registered in the different public dialysis centres in the northeast region during April to October 2022, and 1.40 lakh dialysis sessions were conducted in addition to the services availed in the private sector. The figures are indicative of the rising burden of CKD on the healthcare system in the region. Building awareness of the importance of early and regular health checkups and promoting a healthy diet is crucial for keeping our kidneys healthy. Taking the campaign to the grassroots level in a sustained manner is the need of the hour.